Community-Directed Bacterial Sexually Transmitted Infection Testing Interventions Among Men Who Have Sex With Men: Protocol for an E-Delphi Study in Toronto, Canada

Ann N Burchell; Ryan Lisk; Anna Yeung; Jayoti Rana; Jean Bacon; Jason Brunetta; Mark Gilbert; Dionne Gesink; Ramandip Grewal; Charlie B Guiang; Michael Kwag; Carmen H Logie; Leo Mitterni; Rita Shahin; Darrell Hs Tan

doi:10.2196/13801

Community-Directed Bacterial Sexually Transmitted Infection Testing Interventions Among Men Who Have Sex With Men: Protocol for an E-Delphi Study in Toronto, Canada

JMIR Res Protoc. 2019 Jul 4;8(7):e13801. doi: 10.2196/13801.

Authors

Ann N Burchell^{1

2}, Ryan Lisk³, Anna Yeung¹, Jayoti Rana¹, Jean Bacon⁴, Jason Brunetta⁵, Mark Gilbert⁶, Dionne Gesink⁷, Ramandip Grewal¹, Charlie B Guiang^{2

8}, Michael Kwag⁹, Carmen H Logie¹⁰, Leo Mitterni⁸, Rita Shahin¹¹, Darrell Hs Tan¹

Affiliations

¹ Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
² Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada.
³ ACT, Toronto, ON, Canada.
⁴ Ontario HIV Treatment Network, Toronto, ON, Canada.
⁵ Maple Leaf Medical Clinic, Toronto, ON, Canada.
⁶ BC Centre for Disease Control, Vancouver, BC, Canada.
⁷ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁸ Hassle Free Clinic, Toronto, ON, Canada.
⁹ Community-Based Research Centre, Vancouver, BC, Canada.
¹⁰ Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
¹¹ Toronto Public Health, Toronto, ON, Canada.

PMID: 31274111
PMCID: PMC6637728
DOI: 10.2196/13801

Abstract

Background: HIV-positive and HIV-negative (gay, bisexual, and other) men who have sex with men (MSM) have experienced a dramatic increase in bacterial sexually transmitted infections (STIs)-syphilis, gonorrhea, and chlamydia. STI testing and treatment mitigate adverse health outcomes and substantially reduce transmission; yet, testing rates remain below recommended levels. Innovation is needed to produce the required increases in testing levels, frequency, and the use of appropriate testing technologies in ways that are engaging, nonstigmatizing, and acceptable to men.

Objective: The aim of this study is to build consensus with regard to interventions with the greatest potential for improving local STI testing services for MSM communities in Toronto, Canada.

Methods: Following a literature review of evidence regarding the effectiveness of novel testing interventions, and focus groups, and surveys to describe local barriers and facilitators of testing among MSM, we will conduct a Web-based, modified Delphi study (e-Delphi). We will form expert panels of community members and STI test providers. Panelists will rate potential interventions in terms of their priority, using a 7-point Likert scale from definitely not a priority to definitely a priority. They will also rank their preferences by selecting their top 3 preferred interventions. Surveys will be distributed in 3 rounds, with feedback on the distribution of responses from preceding rounds provided in rounds 2 and 3. We will define consensus as having ≥60% (18/30) members indicate a preference within 2 adjacent response points. Qualitative data on disagreements will be obtained using open-ended text responses to explain for ratings and rankings that are different from the majority.

Results: On the basis of a literature review and identification of barriers and facilitators to STI testing among community members and test providers in Toronto, we have selected 8 potential interventions for inclusion in the e-Delphi panel surveys. These include 4 interventions that streamline STI testing for asymptomatic individuals, 2 interventions that are targeted at clients and 2 interventions that are targeted at providers.

Conclusions: Findings will provide community direction for informed decision making regarding the implementation of STI testing interventions in this setting. They will characterize the intervention climate for innovation to STI testing services, including perceived needs for changes to test delivery, relative priorities for change, and readiness for implementation. These methods may be transferable to other urban jurisdictions experiencing similar epidemics and for other contexts where stakeholder input is needed to manage sensitive areas of concern.

International registered report identifier (irrid): PRR1-10.2196/13801.

Keywords: community-based research; mass screening; patient acceptance of health care; sexual and gender minorities; sexually transmitted diseases.

©Ann N Burchell, Ryan Lisk, Anna Yeung, Jayoti Rana, Jean Bacon, Jason Brunetta, Mark Gilbert, Dionne Gesink, Ramandip Grewal, Charlie B Guiang, Michael Kwag, Carmen H Logie, Leo Mitterni, Rita Shahin, Darrell HS Tan. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 04.07.2019.